HomeMy WebLinkAboutAnderson, John , %OG SOUr,�O
ELIZABETH A.NEVILLE � lG Town Hall, 53095 Main Road
TOWN CLERK 1 * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS . Q i Southold, New York 11971
MARRIAGE OFFICER �� �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _li�'COMM �a �� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER MM �i
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4344-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner JOHN ANDERSON
Mailing Address 1 PO BOX 1329
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 410 NORTH PARISH DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-480-0978
Tax Map No. section 71.00 block 1 lot 3.300
Cross Street NORTH MAIN BAYVIEW ROAD
eirktian4.144
Issue Date: 6/21/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
......
OFFICE OF THE TOWN CLERK �C�V�FOl4' ' ?
TOWN OF SOUTHOLD ��, D Application No. J �
ELIZABETH A.NEVILLE,TOWN CLERK .4 $10.00 - Residential t/
P.O.BOX 1179
cri SOUTHOLD,NEW YORK 11971 �•�� $25.00 - Non-Residential
Telephone t ,i 0, /1'•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No._
Fee $ 1 0. O0
DATE (pin 07
OWNER NAME: i& v 4nderscon
OWNER MAILING ADDRESS: PU 8o I S 2'
ho icl N `1 /19 i
OWNER PROPERTY ADDRESS: y 1 v N O(+ k' ?Circ 5h Dr-7-Do
u,-1--hc) Lc. N t kg / I
OWNER TELEPHONE NUMBER: S - L{g'Q - 0 93
TAX MAP NO. : Section - l Block o t Lot 33
CROSS STREET: N(]1'4 Mcuzy, "--x,,LAjuie. ..,0 Rd .
TYPE OF SYSTEM: Septic Tank V' New ✓ Existing
Cesspool New Existing
Residential ✓ Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: 0 �6((.)
I
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SCDHS Ref.# R10-05-0027 SURVEY OF PROPERTY
AT BA YVIEW
TOWN OF SOUTHOLD
NoRTk SUFFOLK COUNTY, N. Y. •
• A 1000-71-01-33
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• �RI�•,� OCTOBER 4,, 2004
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NOVEMBER 7. 2005 (REVISIONS)
• 1 OCTOBER 3, 2006 (FOUNDATION LOCATION)
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ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION F'4. G+ felt,,,,,
!I ` T�� �'.""
OF SECTION 72090E THE NEW YORK STATE EDUCATION LAW. '4N •• �! ;'
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS ��N • =MONUMENT (631) 765-5�' s' '•.( A 1797
P.O. BOX 909 �7 "
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF '
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ELEVATIONS REFERENCED TO N.G. V.D. 1230 TRAVELER S 04-284 4_2 p,/
WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 V�i-
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